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Acromioclavicular Joint articulates
Between the acromial facet of clavicle & the acromion process of scapula
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The Integrity of the Acromioclavicular joint is primarily maintained by
Extrinsic ligaments
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How many ligaments make up the Coracoclavicular lig
Two
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An Acromioclavicular Joint Dislocation has what clinical implications
- • Joint may dislocate with or without coracoclavicular lig. rupture
- • If ligament ruptures:
- - Shoulder falls inferiorly (from weight of upper limb)
- - May tear fibrous layer of joint capsule
- - Acromion becomes more prominent (projecting) Lateral clavicle may displace superiorly
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Johnny has a direct blow to shoulder causing a "shouler seperation" what has he seperated
The Acromioclavicular Joint Dislocation (Shoulder Separation)
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Pectoralis minor m. is covered by
Clavipectoral fascia
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Pectoralis Major m. has what action, and is innervated by what nerve
- Action
- Clavicular head ONLY: flex humerus
Sternocostal head ONLY: extend humerus from flexed position
2 heads TOGETHER: adduction & medial rotation of arm
- Innervation
- Lateral + Medial Pectoral nn.
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Pectoralis Major m. inserts where
Lateral lip of intertubercular sulcus
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Fracture of the Clavicle has what clinical implications
- •Most commonly fractured bone
- •~80% of fractures occur in middle one-third of shaft
- •Possible deformity due to displacement and overriding of fragments
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Pectoralis Minor m. action and inn.
- Action
- Stabilize scapula
- (draws it inferiorly & anteriorly)
- Innervation
- Medial Pectoral n.
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Serratus Anterior m. action and inn. and test
- Action
- Protract scapula
- Rotate scapula superiorly
- Innervation
- Long thoracic n. (C5, C6, C7)
- To Test
- Press hand of outstretched limb against a wall
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What is a "winged" scapula caused by
It is caused by damage to the serratus anterior. It can affect a person’s ability to lift, pull, and push weighty objects. In some serious cases, the ability to perform activities of daily living such as changing one’s clothes and washing one’s hair may be hindered
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What nerve travels in an inferior direction on the anterior side of the Serratus anterior
Long thoracic n.
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The Brachial a. has its superior end where
On the inferior border of the teres major where it turns into the axillary a.
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What are the superior and inferior boarders of the Axillary a.
The inferior is the teres major muscle, the superior boarder is the Lateral border of the 1st rib
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The Subclavian a. begins where
At the Lateral border, 1st rib
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The Subclavian a. has what branches
Suprascapular a.
Cervicodorsal trunk
Thyrocervical trunk
Transverse cervical a. (deep & superficial brs)
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Where does the Subscapular branch from
Axillary a.
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What does teh
Circumflex scapular a. branch from
Axillary a. preceeds Subscapular a. then the circumflex scapular proceeds from there
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The Arterial Anastomoses Around Scapula are
- Circumflex scapular a.
- Suprascapular a.
- Subscapular a.
- Intercostal a.
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What arteries branch from the Axillary artery: 1st part
Superior Thoracic a.
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What arteries branch from the Axillary artery: 2nd part
- Thoraco-acromial a.
- - Clavicular br.
- - Acromial br.
- - Pectoral br.
- - Deltoid br.
- Lateral thoracic a
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What arteries branch from the Axillary artery: 3rd part
- 1. Subscapular a.
- - Circumflex scapular a.
- - Thoracodorsal a.
- 2. Anterior circumflex humeral a.
- 3. Posterior circumflex humeral a.
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What is the Course of the Cephalic Vein
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The pectoralis minor muscle plays an important role in stabilizing the scapula. The somatic motor innervation for this muscle is most commonly provided by which nerve(s)?
Medial pectoral
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Polymastia is defined as
More then the average pair of breasts, found in the anterior side of the trunk
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Polythelia
More then two nipples
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Amastia
= absence of breast(s)
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Gynecomastia
= abnormally large breasts in males
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What gives the breasts lift
Suspensory ligament (of Cooper)
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Behind the breast is a space called
Retromammary Space
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Anterior cutaneous n. feeds to what, and is a branch of which nerve
- Innervation of the Breast, Intercostal n.
- (T4-T6), coming from the ventral ramus
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Blood Supply of the Breast is
- Internal Thoracic a.
- -Which branch to the Medial mammary brs
- Lateral Thoracic a.
- -Which branch into the Lateral mammary brs
- Posterior intercostal a.
- - Which branch into the Lateral mammary brs
- (from lateral cutaneous brs)
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Breast cancer frequently spreads by
lymphogenic metastasis via the Axillary lymph nodes (can metastasize in lungs, pleura, liver, bones, brain)
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Cancer cells that invade glandular tissue appear as
- - Shortened suspensory ligs
- - Large skin dimpling
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Cancer cells invade lactiferous ducts appear
- - Shortened ducts
- - Retracted, deviated nipple
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Cancer cells interfere with lymph drainage
- - Lymphedema (excess fluid, swelling)
- - ‘Peau d’orange’ Sign:Thickened, puffy skin between small, dimpled pores
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Cancer cells invade retromammary space, pectoral fascia, or interpectoral lymph nodes
- - Breast elevates when pec major contracts
- - To Test: Hands on hips, press while pulling elbows forward
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During a follow-up exam after a modified radical mastectomy of the right breast, you notice that the patient is unable to full abduct her ipsilateral arm. Which nerve is likely to have been injured during this patient’s surgery?
Thoracodorsal
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How can the spine of the scapula be used as a landmark
It marks (in most individuals) the site of T3 vertebrae
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How can the spinous process tip be used as a landmark
It is the on the same plane as T7
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Which provides more stability, cartilaginous or fibrous joints
Fibrous
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What is a highly mobile but relatively unstable joint that is frequently injured (>45% of dislocations)
Glenohumeral Joint
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The Intrinsic ligaments of the glenoid humoral joint are
- - Coracohumeral ligament
- - Glenohumeral ligaments (superior, middle, inferior)
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The Coracoacromial Arch includes
- Coracoid + acromion + coracoacromial lig.
- Osseoligamentous structure (prevents superior dislocation)
- Very strong (forceful superior thrust will fracture humeral shaft or clavicle first)
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Movement of the Pectoral Girdle includes what joints
- •Sternoclavicular (SC) Joint
- • Acromioclavicular (AC) Joint
- • Glenohumeral Joint
- • “Scapulothoracic” Physiological Joint
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Deltoid m. action and inn. and test
- Action
- Abduct arm (after initial 15 degrees)
- Innervation*
- Axillary n. (C5, C6)
- To Test
- Abduct arm against resistance
- (start with arm at approx. 15degrees)
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Teres major m. action and inn.
- Action
- Adduct arm
- Medially rotate arm
- Innervation
- Lower subscapular n. (C5, C6)
- To Test
- The abducted arm is adducted against resistance
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Teres major m. insertion and origin
Inferior angle of the scapula, and medial lip of the intertubercular sulcus of the humerous
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Supraspinatus m. action and inn
Action Abduct arm (initial 15 degrees)
Holds humeral head in glenoid fossa
Innervation Suprascapular n. (C4, C5, C6) To Test Abduct arm from 0 degrees (resting position)
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Infraspinatus m. action inn. and test
Action Laterally rotate arm
Holds humeral head in glenoid fossa
Innervation Suprascapular n. (C5, C6)
To Test Flex elbow with arm adducted, ask patient to rotate laterally against resistance
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Teres minor m.
Action Laterally rotate arm
Innervation Axillary n. (C5, C6)
Holds humeral head in glenoid fossa
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Subscapularis m. action and inn.
Action Medially rotates arm
Holds humeral head in glenoid fossa
Innervation Upper & Lower subscapular nn. (C5, C6, C7)
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Avulsion Fracture of Greater Tubercle symptoms
•Arm is medially rotated
- Intact subscapularis m. pulls arm into medial rotation
- Lack of opposition from lateral rotators of arm
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Glenohumeral Joint Dislocation (Shoulder Dislocation) clinical implications
- • Risk of tear to fibrous joint capsule, glenoid labrum, rotator cuff tendons
- • Anterior dislocation most common (>90%):
- - Humeral head moves inferior to glenoid cavity, anterior to infraglenoid tubercle
- - Intact flexor + adductor mm. pull head into subcoracoid position
- • Patient is unable to use arm, supports it with other hand, arm rotates medially
- • Risk of injury to axillary n. Prone to joint instability & recurrent dislocations
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Quadrangular Space boarders and contents
Contents: axillary n. + posterior circumflex humeral a.
- Teres minor (suprerior)
- Teres major (inferior)
- Long head of tricept (medial)
- Lateral head (Lateral)
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Triangular Space contents and boarders
- Circumflex scapular a.
- Teres major (inferior)
- Teres minor (superior)
- Long head (lateral)
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Triangular Interval contents and boarders
Radial n. + deep artery of arm
- Teres major (superior)
- Long head of tri (medial)
- Lateral head of tri (lateral)
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“Army goes over, Navy goes under” refers to
The Suprascapular a. & n. in respect to the Superior transverse scapular ligament
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Subscapularis is the only muscle that
Is on the anterior side of the scapula and the only one that attaches to the lesser tubericle
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What is the job of the subacromial bursa
To protect the supraspinatus tendon
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Injury to the supraspinatus is very common and will cause
Innability to initiate arm abduction, patient will often swing their body to get the arm above 15 degrees where the delt will take over
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The supraclavicular node is great for checking the status of the nodes because
It is near the surface and next to the clavicle making it an optimal node for palpitations to identify swollen lymph
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Lymph from the right upper limbs are dumped into
The right venous angle (jugular vein) via the right lymphatic duct
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Lymph from the upper left limbs are dumped
Into the left venous angle (jugular vein) via the thoracic duct
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During a physical exam, you palpate an enlarged mass in the axillary region. Based on its location, you suspect that this mass is an enlarged central lymph node. Lymph from which other node does not typically pass through the central node?
Apical
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The only muscle that the dorsal nerve innervate are
Deep intrinsic back muscles
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All of the divisions of the brachial plexus only come from the
Ventral Rami
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Following a traumatic injury to the axillary region, a patient is unable to extend his arm, elbow, wrist and fingers. What component of the brachial plexus has most likely suffered damage in this patient?
Posterior cord
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